Acute pain is a sharp, short-lived, localized pain that occurs as a result of various physical, chemical, trauma, infection, etc. It is both a signal of sorts, alerting the body that it is suffering from some kind of injury and needs immediate attention and timely avoidance; and a symptom, a warning that some kind of disease is occurring in the body, alerting the doctor to find the cause for treatment.
Chronic pain is relative to acute pain. One way to define chronic pain is when the pain lasts for more than 1 month. Another way of defining chronic pain is when the pain persists after the acute injury has healed. Because different types of acute injuries take different amounts of time to heal, the transition between acute pain and chronic pain should be based on the characteristics of the injury, not the timing. Acute pain often responds to tissue damage, while chronic pain is not necessarily a response to a physiological change; sometimes it no longer reflects a disease, but becomes a disease in its own right.
Which pains should be seen by a pain department?
Pain whose cause and disciplinary affiliation is unclear. For example, chronic generalized pain, headache, chest and back pain, abdominal pain, spinal and extremity pain, etc.
Pain that is clearly attributed to a specific department, but for which there is no specific treatment. Such as “postherpetic neuralgia”, residual limb pain after amputation, chronic intractable postoperative pain syndrome after various surgical procedures, etc.
Neck, shoulder, lumbar and leg pain without surgical indication. Certain patients with cervical spondylosis, spinal stenosis, lumbar disc herniation without indications for surgery, and patients with frozen shoulder, osteoarthritis, myofascial syndrome and osteoporosis that usually do not require surgery.
Pain caused by spasmodic embolism of blood vessels and ducts. Severe pain caused by, for example, Raynaud’s disease, angina pectoris, bile duct stones, ureteral stones, etc. Treatment in the pain department can be effective in relieving pain and can sometimes serve as a synergistic treatment for the disease.
Pain caused by certain chronic non-suppurative arthritis. Such as rheumatoid arthritis, ankylosing spondylitis, gout, etc.
Pain of neurogenic origin. Such as central pain, reflex sympathetic dystrophy, burning neuralgia, trigeminal neuralgia, glossopharyngeal neuralgia, occipital neuralgia, intercostal neuralgia, diabetic peripheral neuritis, etc.
Cancer pain. Pain that exists while anti-cancer treatment is being given or after anti-cancer treatment is completed.
Brief description of common conditions in pain department
Phantom limb pain
Phantom limb pain often occurs after limb amputation surgery, where the patient subjectively feels that the amputated limb still exists and is accompanied by severe pain, which is actually a hallucinatory phenomenon, hence the name phantom limb pain.
The degree and nature of phantom limb pain varies greatly and can be pulsating pain, burning pain, pins and needles pain, drilling pain or pressure, tonicity, itching, etc. Most of the pain appears or worsens paroxysmatically, often during quiet time or at night, and can be triggered or aggravated by mood changes, climate change, fatigue or other diseases.
Phantom limb pain is often accompanied by amputation pain, which is the pain in the stump after amputation and often occurs some time after the wound heals. The pain is mostly caused by neuromas in the scar of the amputation stump, which may have scar sclerosis or neuromas, local skin sensory hypersensitivity, and gently touching can cause radiating pain throughout the limb.
Low back pain
Low back pain is a clinically common symptom mainly manifested by pain in the lower back or back, and can be caused by a variety of reasons. It can be classified according to the etiology as follows.
1, low back pain caused by spinal lesions, commonly seen in rheumatoid spondylitis, osteophytes, tuberculous spondylitis, spinal trauma and disc prolapse, etc.
2.Low back pain caused by soft tissue lesions next to the spine, commonly caused by lumbar muscle strain and myofibrosis, etc.
3, low back pain caused by spinal nerve root lesions, commonly caused by spinal cord compression, acute myelitis and radiculitis, etc.
4.Lower back pain caused by visceral diseases, commonly caused by nephritis, urinary tract infection, urinary stones, cholecystitis, gallbladder stones, pancreatitis, gastric and duodenal bulb ulcers, prostatitis, endometritis, adnexitis and pelvic inflammatory disease, etc.
Cancer pain
It is also called cancer pain and advanced cancer pain. Cancer pain is a sensation caused by the transmission of information to the nerve center that the pain site needs to be repaired or regulated, and is one of the main causes of pain for patients with advanced cancer. The causes of cancer pain can be divided into three categories: pain directly caused by tumor, which accounts for about 88%; pain caused by cancer treatment, which accounts for about 11%; and pain indirectly caused by tumor, which accounts for about 1%.
Cancer pain, in the pain treatment, belongs to a special form. Clinical practice proves that the choice of treatment form should depend on the duration, location, nature and degree of pain of cancer pain. At present, in addition to the well-known “three-step treatment” principle for cancer pain, pain treatment specialists at home and abroad follow another treatment principle recommended by the World Health Organization, which is not well known to patients or their families, that is, cancer pain patients should implement the principle of individualized treatment: the treatment for cancer pain patients varies from time to time, from site to site, and from disease to disease. The treatment of cancer pain patients should be individualized according to time, location and disease.
Headache
Headache is a common clinical symptom, and pain confined to the upper part of the skull, including the brow arch, the upper edge of the ear chakra and the area above the line of the external occipital ridge, is usually referred to as headache. Clinically, headaches can be classified according to the mode of onset.
(1) Acute onset of headache: common in cases such as subarachnoid hemorrhage and other cerebrovascular diseases, meningitis or encephalitis;
(2) Subacute onset of headache: such as temporal arteritis, intracranial tumor, etc;
(③) Headache with chronic onset: such as migraine, tension-type headache, cluster headache, drug-dependent headache, etc.
There are many causes of headache, which can be roughly divided into two categories: primary and secondary. The former can not be attributed to a specific cause and can also be called idiopathic headache, such as migraine and tension-type headache; the latter can involve various intracranial pathologies such as cerebrovascular disease, intracranial infection, cranial trauma, systemic diseases such as fever, internal environmental disorders and abuse of psychoactive drugs.
Lumbar disc herniation
Lumbar intervertebral disc herniation (commonly known as sciatica): it is caused by lumbar disc tissue degeneration, injury, rupture of the fibrous ring, extrusion of the nucleus pulposus, and backward protrusion from the ruptured fibrous ring into the spinal canal to compress nerves due to trauma, long-term exertion, strain, uncoordinated exertion, improper posture, etc., which can cause pain, numbness and coldness, soreness and discomfort, cramps, lumbar scoliosis, lower limb muscle It can cause a series of clinical symptoms such as pain in the back and legs, numbness, pain and discomfort, cramps, scoliosis, muscle atrophy in the lower limbs, weakening, abnormal urination and defecation.
The focus of lumbar disc herniation prevention is to reduce the accumulation of injuries. The bed should not be too soft when sleeping. Long-term ambulatory workers need to pay attention to the height of tables and chairs and change their posture regularly.
Those whose occupational work requires frequent bending movements should regularly stretch their waist and chest and use a wide belt.
Trigeminal neuralgia is the most common neurological disease of the brain, mainly manifested by recurrent paroxysmal severe pain in the distribution area of the trigeminal nerve on one side of the face, with an incidence rate of 52.2/100,000 in China, slightly more in women than in men, and the incidence rate can increase with age. Trigeminal neuralgia mostly occurs in middle-aged and elderly people, with more right-sided than left-sided. The disease is characterized by sudden onset, stoppage, lightning-like, knife-like, burning-like, persistent, intolerable and severe pain in the distribution area of the trigeminal nerve on the head and face. The pain can be severe when speaking, washing the face, brushing the teeth or breezing, or even when walking. The pain lasts for several seconds or minutes, and it comes in periodic episodes, with intervals between attacks as in normal people.
Trigeminal neuralgia can be divided into two categories: primary (symptomatic) trigeminal neuralgia and secondary trigeminal neuralgia, of which primary trigeminal neuralgia is more common. Primary trigeminal neuralgia is defined as having clinical symptoms, but the application of various examinations does not reveal organic lesions related to the onset of the disease. Secondary trigeminal neuralgia has clinical symptoms, while clinical and imaging examinations can reveal organic diseases such as tumor, inflammation, vascular malformation, etc. The etiology and pathogenesis of trigeminal neuralgia have not yet been clearly established.